Tuğrul GÖNCÜ, İbrahim ÖZERCAN, Ilgın KARACA, Şenol YAVUZ, Ahmet ÇEKİRDEKÇİ

Vasküler injüri sonrası oluşan intimal hiperplazi üzerine perindoprilin etkisi

Amaç: Rekonstrüktif cerrahi girişimlerden sonra restenoz gelişiminde vasküler duvarda düz kas hücre migrasyonu, proliferasyonu ile ekstrasellüler matriks birikimi sonucu oluşan ve intimal hiperplazi olarak da adlandırılan duvar kalınlaşması sorumlu tutulmaktadır. Anjiyotensin II'nin intimal hiperplazi üzerinde önemli bir rol oynadığı düşünülmektedir. Bu çalışmanın amacı, bir anjiyotensin konverting enzim inhibitörü olan perindoprilinin deneysel balon kateter injürisi sonrası oluşan neointimal hiperplazi üzerindeki etkisini incelemektir. Materyal ve Metod: 18 adet Yeni Zellanda cinsi erkek beyaz tavşan balon kateter injürisinden önce 7 gün, injüriden sonra 14 gün süreyle oral olarak perindopril 2 mg/kg/gün verilen perindopril grubu (9 denek) ile herhangi bir ilaç tedavisi verilmeyen kontrol grubu (9 denek) olarak 2 gruba ayrıldı. Deney süresinin bitiminde alınan iliak arter kesitleri histopatolojik olarak incelendi. Dijital planimetre ile intimal ve medial alan hesaplanarak her bir kesitteki intima / media oranı elde edildi. Bulgular: Perindopril grubunda ortalama arteriyel basınç değerleri, kontrol grubu ve başlangıç değerleri ile karşılaştırıldığında istatistiksel olarak anlamlı oranda azaldı (sırasıyla p < 0.0003, p < 0.0005). Kontrol grubundaki deneklerde intimal alan, balon kateter injürisi sonrası 14. günde normal arterle karşılaştırıldığında anlamlı oranda arttı (p < 0.0002). Perindopril grubunda neointimal alan yaklaşık olarak %59 oranında azaldı (p < 0.0005). Perindopril grubunda intimal / medial alan oranı, kontrol grubuna göre anlamlı olarak azaldı (p < 0.0003). Sonuç: Perindoprilin uzun süreli kullanımının vasküler rekonstrüktif girişimlerden sonra restenoz gelişiminin engellenmesinde yararlı bir ajan olabileceği düşüncesindeyiz.

The effect of perindopril on the intimal hyperplasia occurring after vascular injury

Background: The wall thickness named as intimal hyperplasia resulting from smooth muscle cell migration, proliferation and extracellular matrix accumulation on the vascular wall is responsible of development of restenosis after reconstructive surgical procedures. It has been considered that angiotensin II plays an important role on the intimal hyperplasia. The aim of this study was to examine the effect of perindopril, an angiotensin converting enzyme inhibitor, on the neointimal hyperplasia occurring after experimental balloon catheter injury. Metods: Eigthteen male New Zealand White rabbits, were divided into two groups consist of no treatment (control, n = 9) group and perindopril group (n = 9) administered orally 2mg/kg/day of perindopril 7 days before and during 2 weeks after balloon catheter injury. Iliac artery specimens were examined histopatologically at the end of the study. Intimal and medial area were calculated with use of digital planimetry and intimal area-to-medial area ratio was obtained for each vessel. Results: Mean arterial blood pressure was significantly lower in perindopril group than in control group and initial values (respectively, p < 0.0003, p < 0.0005). In the control group, intimal area was significantly higher after 14 days of balloon catheter injury when compared with normal artery (p < 0.0002). In perindopril group, the percent decrease in neointimal area was approximately 59% (p < 0.0005). Intimal area-to-medial area ratio was significantly decreased in perindopril group when compared with control group (p < 0.0003). Conclusion: We concluded that long-term use of perindopril may be a useful agent to prevent occurrence of restenosis after reconstructive procedures.

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